During pregnancy, the placenta supplies a growing
fetus with nutrients and water, as well as produces
a variety of hormones to maintain the pregnancy. In
early pregnancy, hormones can cause increased
insulin secretion and decreased glucose produced by
the liver, which can lead to hypoglycemia (low blood
glucose levels). In later pregnancy, some of these
hormones (estrogen, cortisol, and human placental
lactogen) can have a blocking effect on insulin, a
condition called insulin resistance.

As
the placenta grows, more of these hormones are
produced, and insulin resistance becomes greater.
Normally, the pancreas is able to make additional
insulin to overcome insulin resistance, but when the
production of insulin is not enough to overcome the
effect of the placental hormones, gestational
diabetes results or there may be worsening of
pre-existing diabetes.

What Causes
Diabetes During Pregnancy?

Glucose, a sugar
that results from the digestion of food, is the
body's main nourishment. During pregnancy, your body
also supplies your baby with glucose, which is
delivered through the placenta and is your baby's
only source of nourishment.

The placenta also
makes certain hormones to help the baby develop. But
these hormones make it harder for your body to use
insulin. About halfway through pregnancy, the
placenta increases its production of these
anti-insulin hormones.

If
your body makes too many anti-insulin hormones, they
can block the movement of glucose from your
bloodstream into your cells. This is called insulin
resistance. At the same time, your pancreas may not
be able to produce enough insulin. When too much
glucose builds up in your bloodstream, diabetes can
result.

Who Is At Risk?

Several factors
increase your chances of developing diabetes during
pregnancy. These include:

A family
history of diabetes

Previously
giving birth to a stillborn baby or to a baby
weighing more than nine pounds

Obesity

Being over
age 25

Being
African-American, Native-American or Hispanic

How Does
Diabetes Affect Pregnancy?

In
women with gestational diabetes and type 2 diabetes,
the sugar (glucose) in your blood directly affects
the size of your baby. If your blood sugar level is
high, the baby gets too much nourishment and
overgrows. This can lead to a condition called
macrosomia or "fat" baby. Macrosomia causes problems
for both you and your baby.

What Are The
Risks To The Baby?

Babies who get too much sugar (glucose) from their
mother's blood accumulate fat around the shoulders
and trunk. That can make them too difficult to
delivery vaginally. Your doctor may recommend
delivering the baby early.

Higher risk
for obesity and type 2 diabetes later in life
for the baby

Jaundice
(a yellowish discoloration of the skin) two to
three days after birth

Risks associated with type 1 diabetes include:

Low blood sugar at birth

Breathing problems at birth

Jaundice two to three days after
birth

Increased chance of major birth
defects

What Are The
Risks To The Mother?

Risks associated
with gestational and type 2 diabetes include:

Possible need
for cesarean delivery

Pregnancy-related high blood pressure and
swelling of the hands and feet

Urinary tract
infections

An increased
chance of developing diabetes later in life or
in a subsequent pregnancy

Risks associated with type 1 diabetes include:

Premature labor and delivery

Possible need for cesarean
delivery

Pregnancy-related high blood
pressure and swelling of the hands and feet

Urinary tract infections

Buildup of ketones (harmful
acids) in the blood

Possible worsening of eye disease

Possible (reversible) progression
of kidney disease

How Can I Avoid
Complications?

Problems associated with diabetes in pregnancy are
manageable and preventable. The key to prevention is
careful control of your blood sugar as soon as
gestational diabetes is diagnosed.

Women with pre-existing diabetes
should get their blood sugar under control three
to six months before conception, to lessen the
risk of birth defects.

Gestational diabetes, which
starts later in pregnancy, does not cause birth
defects.

Will My Baby Be
Healthy?

During pregnancy, several tests will be done to make
sure your baby is developing properly and to help
predict the time of delivery.

Ultrasound
- This test involves passing a special wand over
the skin of the abdomen. Sound waves are
transmitted into the body and bounce back,
creating an image that shows the growth and
development of the baby.

Alpha-fetoprotein test - This is a blood
test that detects a particular protein produced
by the baby's liver. Abnormal levels of
alpha-fetoprotein (AFP) indicate a high risk for
certain types of birth defects.

Amniocentesis - In this test, a long thin
needle is inserted into the abdomen and a sample
of amniotic fluid (the fluid that surrounds the
baby within the uterus) is taken. Cells in the
fluid help doctors determine if the baby's lungs
are mature enough to withstand early delivery.

Non-stress
test - A fetal monitor, strapped to the
mother's abdomen, records the baby's heart rate
for a short period of time. This reading helps
doctors assess the health of the baby in the
last weeks of pregnancy.

Fetal
monitoring - During labor and delivery, a
fetal monitor keeps constant track of the baby's
heart rate in order to detect the first
indications of distress.

Screening and
Diagnosis

Screening for
gestational diabetes is a routine part of prenatal
care. Most health care providers recommend a blood
test known as a glucose challenge test between 24
and 28 weeks of pregnancy or earlier if you're at
particularly high risk of gestational diabetes.

You'll begin the
glucose challenge test by drinking a syrupy glucose
solution. One hour later, you'll have a blood test
to measure your blood sugar level. A blood sugar
level below 130 to 140 milligrams per deciliter (mg/dL)
is usually considered normal on a glucose challenge
test, although this may vary at specific clinics or
labs. If your blood

Sugar level is
higher than your clinic's threshold; you'll likely
need a second test to confirm the diagnosis.

For the follow-up
test, you'll be asked to fast overnight. Then you'll
drink another sweet solution this one containing a
higher concentration of glucose and your blood sugar
level will be checked every hour for a period of
three hours. If at least two of the blood sugar
readings are higher than normal, you'll be diagnosed
with gestational diabetes.

If
you're age 25 or younger and have no risk factors
for gestational diabetes, there's some debate about
whether gestational diabetes screening is needed.
Some health care providers argue that younger women
don't need the test. Others say that screening all
pregnant women no matter their age is the best way
to catch all cases of gestational diabetes.

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